The next step on health care: Let the states decide

Sen. Bill Cassidy (R-La.) (Michael Reynolds/EPA)

ByBill Cassidy

July 14, 2017

Bill Cassidy, a Republican, represents Louisiana in the U.S. Senate.

We do not know whether Senate Republicans will pass the latest plan to replace Obamacare. But something must be done. Families cannot continue to pay ever-higher premiums. President Trump promised to repeal and replace the law, and he clearly cares about the issue. Something must give. What will that be?

Doing nothing is not an option. One-third of counties have only one insurer in their marketplace, and more than 40 have none. Premiums in the individual market have more than doubled on average since Obamacare took effect. If Trump chooses not to continue the Obama administration’s cost-sharing reduction payments to insurance companies, which a federal judge found unconstitutional, premiums will increase even more than the current forecast and insurance companies will continue to exit the exchanges.

One way forward is the approach that Sen. Lindsey O. Graham (R-S.C.) and I laid out in the Graham-Cassidy amendment to the Senate health-care bill. This amendment invokes traditional conservative principles and would devolve power to states. It would ensure access to adequate coverage while allowing a state to craft solutions specific to that state. Congress has already done this with Temporary Assistance for Needy Families, Medicaid and other programs.

Under the amendment, each state would receive a set level of federal assistance based on the size of its eligible population, cost of care and other factors. If a state’s eligible population grew, the amount it received would likewise increase.

Congress would give states guidelines to ensure adequate coverage; for instance, requirements covering preexisting conditions would stay in place. But states would be free to craft their own system to best address the needs of patients in their states.

Alaska has 8 percent of the population of New Jersey — spread over a land area 76 times larger. Clearly, states should be allowed to develop solutions specific to them. Obamacare showed that coercing states and patients into a system not designed with their needs in mind does not work and is resisted.

By returning power and flexibility to the states, we immediately move health care closer to those affected. Then, after settling health care, Congress could move on to other issues.

There must be a replace with repeal. Trump campaigned promising a replace bill that continued coverage, cared for those with preexisting conditions, and eliminated individual and employer mandates while lowering premiums. He repeated similar ambitions for his Obamacare replacement in a Post interview just before his inauguration. Congress should not endanger the fulfillment of these promises.

Every senator and representative, regardless of party, wants to do what is best for their constituents. Some Democrats think the current system is working in their states. Well, it’s not working in Louisiana and many other states across the country. To build consensus and create a passable bipartisan bill, we need to let states take care of themselves and give power back to patients. Let a blue state do a blue thing and a red state such as mine take a different, conservative approach.

I ask Republicans and Democrats to come together to accomplish Trump’s goals. Democratic senators can passively sit back, hoping that replacing Obamacare is done poorly and that the electoral anger directed toward Democrats for the past eight years turns on Republicans. But hoping for political gain would come at the expense of patients and states.

Returning the decision-making power to the states is not a Republican plan or a Democratic plan, but an American plan that reflects the faith in states held by our Founding Fathers.

Americans are asking us to set aside partisanship when it comes to issues of greatest concern. They are asking that we in the Senate put party behind us and put the needs of the people first. No senator in either party should sit on the sidelines. If Republican or Democratic senators, who ran for office pledging to make insurance more affordable, forgo taking action for whatever reason, their voters deserve to be angry.